Health leaders said bringing together a mental health family, crisis services and psychiatric emergency room in one South Carolina area could create a model for the entire state.
The Department of Health and Human Services leads a task force that includes the Medical University of South Carolina, other health care systems, and state agencies. The group held its first meeting at the end of August and will meet again at the end of September, to be followed by monthly meetings.
The initial focus is on establishing a behavioral health care system in the Pee Dee area that includes new mental health hospital beds. Robbie Kerr, director of HHS, said the average number of such beds is 2,600, but at Pee Dee it’s close to one bed for every 7,000 people.
The department has $65 million in funding from the state legislature for this effort, but it can also spend other one-time money it has, in partnership with MUSC and McLeod Health.
“It’s one of the most under-resourced areas of the inland family in the state,” Kerr said. “So we’re going to address that, and MUSC is working closely with us on developing proposals that we hope will fund very quickly to make that happen.”
It is still decided where you will go in the area. MUSC and McLeod are considering multiple locations in and around Florence.
He said the goal was to have a plan in place by January that could be presented to the governor and legislature.
“I’d like to go into January and say, ‘You’ve spent your money wisely with us,’ in the sense that we are giving you plans for the legislature to see,” Kerr said.
mental health care model
Planning and building inpatient beds will take longer, but a whole host of other details about the model are still being studied, said Dr. Patrick J. Cowley, chief executive of MUSC Health System.
“Not everyone needs inpatient (treatment),” he said. “Some people will be fine in the crisis stabilization center. Some people will be fine if they stop quickly in the psychiatric emergency room.”
The state has already identified a shortage of crisis stabilization units, centers where patients can go for a short period of intensive treatment, as a real need for South Carolina; The only unit of this type is in Charleston and is currently running at half capacity. The SC’s Department of Mental Health is working to establish other departments across the state, with talks in Columbia, Greenville and Anderson at various stages.
Kerr said Pee Dee’s model will also look at creating new units but with an emphasis on connectivity.
“We would like to build it and network it” with other mental health resources, such as mobile crisis teams, he said.
Kerr said the idea of a dedicated psychiatric emergency room is also a new concept to consider.
“Do we have dedicated mental health emergency rooms and how do they handle referrals?” He said. “This will be the committee’s biggest focus in the beginning.”
It’s a problem that MUSC deals with “every day,” Cowley said. “Speaking every day, there are 20-30 patients going up to our emergency room (waiting room), only in Charleston, with the majority of those patients (having) biological behavioral problems.”
He said it happens all over South Carolina.
“This happens in every emergency room across the state, to one degree or another,” Cooley said. Kerr said these hospitals are looking for solutions and the goal of Project Pee Dee is to try to put together something that works for them.
“We kind of use Pee Dee as our incubator for this,” he said. “While the network we hope is statewide, we’re going to test things out at Pee Dee, use it as a model, and hopefully roll things out very quickly in the state.”
It includes looking at important questions, Cowley said, such as whether the emergency psychiatric department needs to be located next to a regular emergency room, where the crisis is installed, and where outpatient care clinics are linked to inpatient beds.
Dr. David J. Cole, president of MUSC, said communication is key to the model and providing the right care at the right time.
“It’s about access and continuity of care. These are the first steps,” he said. It’s one thing to have crisis stabilization but “it’s unacceptable, if you’re in a crisis situation, to have a follow-up appointment with you in four months,” Cole said. “It just doesn’t work.”
It also means dealing with the opioid crisis and making sure mental health services don’t rule out drug and alcohol treatment, Kerr said. Some estimate that nearly half of mental health patients also have a substance abuse problem, and vice versa. Because of the way these services are currently regulated, we are “isolating and isolating those treatments,” Kerr said. “We have to figure out how to bring these services together in a (shared) environment. This is one of the challenges we will look at closely.”
This is currently a real problem for mental health providers, Cowley said.
“We get this all the time,” he said. “We have a patient, we refer him to a provider and they will say, ‘I don’t treat anyone with alcohol or drug abuse (problems).'” ” Or vice versa.”
bridging the gaps
Even as they look to revamp the system, Palmetto State faces an acute shortage of service providers. As of September 9, the state’s Department of Community Mental Health Services had 515 vacancies mostly in clinical positions, partly due to a lack of competitive salaries, said Deborah Blalock, deputy director of the department. Cole said that while there may not be a quick and easy solution to the workforce problem, there are better ways to use the state’s existing resources.
“We are innovative in terms of changing the paradigm” of care, he said. “We have tremendous strengths in terms of telehealth, which is making a huge impact in the delivery of behavioral health services and the utilization of our providers. I think it is a long-term commitment to training more providers, but changing the paradigm for how the care that is provided will help the workforce. to meet the need over time.
Mark Sweetman, MUSC’s head of government affairs, said state leaders understand this and were ready to support it when they were asked to help fund workforce development last year.
“From a legislative standpoint, I’ve never seen a cause with this much support, from the Governor, Director Kerr, the legislative leadership, the House and the Senate, all on the same page,” he said. “They gave it in a heartbeat.”
Cooley said that from the hospital’s perspective, there is a lot of interest in having a new model for how to respond to the current shortage of crisis services.
“I don’t see this as a MUSC thing at all,” he said. “Other hospital systems are getting involved. There is a lot of interest. I hear it through the Hospital Association.”
Kiir said it could also not fall to the state to lead and fund it.
“If we try to treat this as a public initiative, it will fail,” he said. “It should be a comprehensive initiative for all service providers.”
Cole said that doing nothing is not an option for anyone right now.
“In my opinion, we are on the very edge of a behavioral health crisis, a tsunami, whatever term you want to use,” he said. “We have to address it. It affects our society on many levels.”